1240Superego

awareness of suicide and its risk factors, enhancing

services and programs throughout the country, and
advancing the science of suicide prevention.
Thomas E. Ellis and
Pamela R. Tenney
See also Assisted Suicide, Cluster Suicide, Parasuicide

Further Readings and References

American Association of Suicidology, http://www.suicidology

.org
American Foundation for Suicide Prevention, http://www.afsp
.org
Colt, G. H. (1991). The enigma of suicide. New York: Simon
& Schuster.
Ellis, T. E., & Newman, C. F. (1996). Choosing to live: How
to defeat suicide through cognitive therapy. Oakland, CA:
New Harbinger.
Hawton, K., & van Heeringen, K. (2000). International handbook
of suicide and attempted suicide. Chichester, UK: Wiley.
Jamison, K. R. (1999). Night falls fast: Understanding suicide.
New York: Knopf.
Maris, R. W., Berman, A. L., & Silverman, M. M. (2000).
Comprehensive textbook of suicidology. New York:
Guilford.
Samaritans, http://www.samaritans.org
Suicide Awareness Voices of Education, http://www.save.org
Suicide Prevention Action Network, http://www.spanusa.org

SUPEREGO
Sigmund Freud coined the term superego in 1923
in his work The Ego and the Id. In that work, Freud
developed what has been called his structural model
of the mind. In that model, the mind is divided into
three psychic agencies: the ego, the id, and the
superego. The superego refers to the part of the mind
responsible for conscience. Self-criticism, shame, and
guilt emanate from the superego, as does self-acceptance. The superego evaluates the self in terms of
moral standards and approves or disapproves of the
self accordingly.
Freud viewed the superego from a developmental
perspective. The superego is based on identifications
with parental approval and disapproval. Yet the child
perceives parental approval and disapproval through
the distorting prism of his or her own wishes, conflicts, anxieties, and defenses. Freud believed that the
superego arises as a resolution of the Oedipus complex.

The child wishes to have an incestuous relationship

with the desired parent and wishes to murder the rival
parent. These forbidden wishes give rise to feelings of
guilt and fears of retribution, such as castration for the
little boy. The fear of punishment for these forbidden
incestuous and parricidal wishes becomes the basis of
the superego. The child identifies with the rival parent
and decides to marry someone like the desired parent
when the child grows up.
The superego is perceived as omnipotent and
omniscient just as the young child views the parents
as all-powerful and all-knowing. The child is motivated to listen to the superego not simply out of fear
of punishment but also out of a wish to grow up and
enjoy adult prerogatives, privileges, and powers, especially those related to adult sexuality. Freud believed
that precursors to the superego could be seen in
the childs acceptance of parental discipline during the
anal phase of psychosexual development when the
child is being toilet trained.
Melanie Klein added to Freuds superego theory
by suggesting an earlier origin of the superego in the
infants initial relationship with a nurturing mother
during the oral phase of development. Klein suggested
that the infant deals with frustration of dependency
needs by projecting that infantile rage onto the mother,
who is then perceived as a bad, angry mother. Fear
of a bad mother who is hostile to the childs needs
becomes the basis of a particularly harsh and punitive
superego. Klein suggested that the child feels a primitive form of guilt when the child worries that his or
her aggression has damaged the mother. The urge to
make reparations, to assume responsibility for fixing
the damage wrought by ones own aggression, becomes
the inspiration for mature superego functioning.
In psychoanalytic theory, the superego is multifaceted. It has permissive and prohibitive, harshly punitive and lovingly accepting, rational and irrational
aspects. The superego is only partially conscious,
since the harsher aspects are often repudiated out of
fear of punishment. Certain forms of psychopathology
have been thought to derive from an unduly harsh
superego. Depression derives from a cruel superego
that generates irrational self-blame. Obsessional selfdoubt and worry derive from a perfectionistic superego that is excessively fault-finding.
Lawrence Josephs
See also Ego; Ego Development; Freud, Sigmund; Psychoanalytic Theory

Surrogate Mothers1241

Further Readings and References

INCIDENCE AND TECHNOLOGY

Freud, S. (1923). The ego and the id. Standard edition of the
complete psychological works of Sigmund Freud (Vol. 19,
pp. 166). London: Hogarth Press.
Klein, M. (1975). Love, guilt, and reparation and other works,
19211945. New York: Delta.

At least a thousand births a year in the United

States result from gestational surrogacy. Depending
on the reasons for the couples childlessness, the technology involved ranges from fertilization in vivo with
sperm from a donor or from the intended caregiving
father, to hormonal stimulation of ovulation to obtain
an ovum from a donor or from the intended caregiving mother, followed by in vitro fertilization with
sperm from a donor or the intended caregiving father,
and transfer of the fertilized ovum to the uterus of the
gestational surrogate.

SURROGATE MOTHERS
The term surrogate mother is occasionally used
to mean the foster caregiver of orphaned children,
often an older sibling or a maternal relative. Most
commonly, however, surrogate motherhood refers to
participation in the conception and gestation of a
child by a woman who will not be a primary caregiver
after the child is born. A woman may act as a surrogate mother when she becomes pregnant by artificial
insemination, gives birth, and surrenders the child to
another woman who will care for the child and act as
the childs social and emotional mother. She may also
be termed a surrogate mother when another womans
fertilized ovum is implanted and develops to term in
her uterus, and the newborn infant is given to another
woman (sometimes the source of the ovum, sometimes not) who will act socially and emotionally in
the role traditionally called mother, whom we may
call the caregiving parent. In either case, the woman
who carries the child may be called a gestational surrogate, and this term may be preferable to surrogate
mother because it does not imply a social role as
mother does.
HISTORICAL BACKGROUND
Some forms of artificial insemination have been
possible as long as fertilization has been understood,
but gestational surrogacy as a practice first came to
public notice with the much-publicized case of Mary
Beth Whitehead and Baby M in 1986. Mrs. Whitehead
had entered into a contract with a childless couple,
agreeing to be inseminated with the husbands sperm,
to bear and surrender the resulting child, but after the
birth she was reluctant and gave up the little girl only
after months of negotiation. By 1994, complex forms
of assisted reproductive technology (ART) had developed, creating a variety of beginnings for gestational
surrogacy, as well as attempts to solve some of the legal
problems inherent in the practice.

OUTCOMES AND RISKS

Risks to Infant
Risks are increased with all forms of gestational
surrogacy that involve ART procedures rather than
simple artificial insemination. For all ART procedures,
whether or nor gestational surrogacy is involved, the
proportion of resulting live-born infants is about 25%.
The increased likelihood of multiple births with ART
is associated with complications of pregnancy, premature births, low birth weights, and long-term disabilities resulting from these conditions.
Risks to Donors,
Surrogates, and Families
Ovum donors in ART procedures experience some
medical risk factors connected with stimulation of
ovulation by medications, as well as the surgical procedure that retrieves the ovum. In some procedures,
the gestational surrogate also undergoes increased risk
because of medical and surgical treatment. The gestational surrogate has a slight increase of risk factors as
a result of childbirth, as compared with her risk if she
did not bear a child.
Families with a history of childlessness and the
experience of ART, with or without gestational surrogacy, have emotional concerns that are different from
those of natural family formation, and may benefit
from counseling for parents and for children as the
children grow up.
LEGAL AND ETHICAL ISSUES
Early gestational surrogacy arrangements were
often made as personal contracts, with the potential for